The use of a cyclosporin-ketoconazole combination: making renal transplantation affordable in developing countries.

Objectives: The costs of immunosuppressive drugs in renal transplant recipients remains prohibitively high. Ketoconazole (KZ) has, in limited studies, been shown to significantly reduce the dose of cyclosporin (CyA) after renal transplantation. We report our long-term experience with the use of KZ in a large group of renal transplant recipients.

Experience with the use of an iron polymaltose (dextrin) complex given by single total dose infusion to stable chronic haemodialysis patients.

Background: Many studies of anaemia in patients on chronic haemodialysis have noted a high prevalence of iron deficiency despite oral iron supplementation. Our study examined the effect of intravenous iron given as bolus replacement. As the majority of these patients were not receiving concurrent recombinant human erythropoietin (rhEPO) it allowed an analysis of the safety and efficacy of intravenous iron as a single agent.

Withdrawal of cyclosporine in renal transplant recipients with acute tubular necrosis improves renal function.

In this study, patients with acute tubular necrosis (ATN) after renal transplantation were prospectively randomized to either conventional immunosuppression or withdrawal of cyclosporine and replacement with anti-thymocyte globulin (ATG). The patients treated with cyclosporine withdrawal and ATG had a significantly shorter duration of ATN (8.9 +/- 1.

Renal transplantation from a living related donor with a retrocaval ureter--a note of caution.

In our study we describe a renal transplant from a living related donor who was found to have a retrocaval ureter. The retrocaval ureter is a rare congenital anomaly resulting from a defect in the embryological development of the ureter and the inferior vena cava (IVC). The compression of the ureter between the IVC and the vertebrae can result in progressive hydronephrosis.

Identification of two novel mutations in the hydroxymethylbilane synthase gene in three patients from two unrelated families with acute intermittent porphyria.

We have screened the hydroxymethylbilane synthase cDNAs of 3 patients from 2 families suffering from acute intermittent porphyria (AIP) from Scotland and South Africa using heteroduplex and chemical cleavage of mismatch analyses. Direct sequencing was used to characterise the mutations. The two novel mutations identified were a missense mutation at nucleotide position 64 in exon 3 (R22C) and a single base-pair deletion in exon 15.

Acute intermittent porphyria: the in vitro expression of mutant hydroxymethylbilane synthase.

Acute intermittent porphyria (AIP) is an inborn error of haem biosynthesis caused by a variety of mutations in the gene coding for hydroxymethylbilane synthase (HMB-S). The entire coding sequence of this gene, from each of three South African AIP patients, was therefore screened for mutations using chemical cleavage mismatch (CCM) analysis and any changes detected characterized by DNA sequencing. Three single base changes were identified; a G77 to A in exon 3, a C346 to T in exon 8 and a G518 to A in exon 10.

Detection of four mutations in six unrelated South African patients with acute intermittent porphyria.

We have screened the hydroxymethylbilane synthase cDNA from six South African patients with acute intermittent porphyria, using a combination of chemical cleavage mismatch analysis and direct sequencing of asymmetrically amplified PCR products. Four mutations were detected, a novel T insertion (771insT) and three missense mutations (R26H, R116W and R173Q). The 771insT mutation produces a stop codon, thirty-three codons downstream and a loss of approximately 20% of the protein is predicted.

Abdominal tuberculosis: still a potentially lethal disease.

The findings in a 4-yr survey of 82 patients with abdominal tuberculosis are described and compared with those encountered in previous surveys. Fourteen cases of intestinal, 11 of mesenteric-lymphnodal, and 57 of peritoneal tuberculosis were identified. The disease occurred essentially in patients living under worsening socioeconomic conditions, and 51 of them had associated pulmonary tuberculosis.

Right ventricular infarction mimicking extensive anterior infarction.

Two patients with inferior infarction complicated by right ventricular infarction are presented. Both manifested electrocardiographic changes involving the anterior chest leads with initial S-T segment elevation followed by loss of R waves and the development of QS complexes mimicking anterior infarction. Cardiac catheterization showed right coronary artery occlusion with normal left coronary system and anterior wall motion in each case.

Drug-resistant malaria in Africa. A case report and review of the problem and treatment.

A case of Plasmodium falciparum malaria resistant to chloroquine occurring in a patient taking Fansidar (a combination of pyrimethamine and sulphadoxine) regularly as prophylaxis is reported. It seems likely that the malaria infection was acquired in Tanzania. It is probable that more such cases will be seen, and complacency regarding the emergence of drug-resistant P.

The role of the cheek pouch in effecting transplantation immunity in the hamster.

The cheek pouch of the hamster is alymphatic. Molecules, too large to penetrate the vascular endothelium, reach general circulation by slowly diffusing through the cheek pouch membrane to vessels found in the connective tissues in the neck and these vessels drain primarily into the superficial cervical node. The tissues of the cheek pouch membrane limit the diffusion of large particles and it is this "barrier" which explains, in part, the "privilege" conferred by the cheek pouch.